AMA Pushes for Permanent Doctor Pay Fix

WASHINGTON -- The American Medical Association (AMA) was hoping the momentum of healthcare reform would carry along legislation that would finally repeal the much-despised sustainable growth rate (SGR) formula that governs Medicare payments to doctors.

But with the reform movement floundering with the election of Massachusetts Republican Scott Brown to the U.S. Senate, the AMA and other groups are renewing efforts to make sure Congress doesn't bypass doctor payment issues this year.

Absent further action by Congress, payments under Medicare will be cut by 21% in March.

In January, the House and the Senate both passed a two-month stopgap measure to postpone the cuts, but they expire at the end of February.

In years past, Congress has voted at the eleventh hour to stall planned payment cuts seven times, but advocacy groups such as the AMA and AARP have been pushing hard for a permanent solution.

The SGR was developed in 1997 as a way to prevent Medicare payments from growing too quickly. The formula indexes reimbursements to changes in the gross domestic product (GDP). But healthcare spending has been growing much faster than GDP, so applying the SGR formula would have resulted in actual reimbursement cuts year after year.

So every year, physician groups have gone to Congress asking for an override. So far, they've been successful, but $210 billion of public debt has accumulated as a result of not implementing the cuts.

Months ago, members of Congress promised to repeal the SGR as part of healthcare reform, but those measures were stripped out of the bills to bring down the total costs of the legislation.

After it was clear that a doctor payment fix wouldn't be part of a healthcare reform package, the AMA lobbied for a stand-alone bill, which failed in the Senate, but later cleared the House.

It's likely that Congress will just approve yet another one-year fix. But Nancy Nielsen, MD, immediate past president of the AMA, said pushing the debt down the road will only make it more expensive to pay off when Congress does finally approve a permanent fix.

"We absolutely do not want a temporary fix," Nielsen told reporters at a Thursday press conference. "That is not fiscally responsible."

Cecil Wilson, MD, president-elect of the AMA, who joined the press conference via live feed from Bismark, N.D., agreed.

"We've had assurances from Sens. Reid and Baucus that now is the time for a permanent fix," he said, referring to Majority Leader Harry Reid (D-Nev.) and Finance chairman Max Baucus (D-Mont.).

But those assurances were no doubt given before Massachusetts state senator Scott Brown came from behind to beat Massachusetts attorney general Martha Coakley for a U.S. Senate seat, breaking the Democrat's 60-seat, filibuster-proof hold in the Senate.

While Democrats and Republicans appear to agree with the AMA and its allies that the SGR is unsustainable and unfair, not a single Republican senator voted to support a procedural measure that was seen as a test vote for repealing the SGR.

When asked how the one-vote change in the Senate will change the likelihood of permanently repealing the SGR, Nielsen said the AMA will continue work on convincing all senators to fix doctor payments.

"We believe that people of good will on both sides of the aisle are caucusing and trying to figure out how they're going to go forward," Nielsen said.

"We look forward to working with all of them and certainly the new senator from Massachusetts. We certainly want to make sure that the new senator understand the problem of the SGR and why a permanent repeal is absolutely necessary."

The "doctor payment fix" bill passed by the House -- which would replace the SGR formula a with an annual payment increase equal to 1% more than the growth in the GDP (2% more for primary and preventive care physicians) was placed on the Senate's legislative calendar on Wednesday, but there is no indication of when the measure will be taken up.

As political strategists in many sectors are trying to make sense of how a little-known Republican could win an election in a largely Democratic state, those involved in the push for an SGR repeal are also trying to glean lessons from the election.

"One message we need to take from this is we need to listen to issues real people talk about," Nancy LeaMond, executive vice president of AARP told reporters. For example, she said, seniors are having increasing difficulty finding a doctor who will take Medicare patients, she said.

One in four Medicare patients is having trouble finding a primary care physician, according to AMA board member Ardis Hoven, MD.

The AMA and AARP, along with the Military Officers Association of America, hosted a Webcast Thursday with representatives in states where new TV ads will air, urging constituents to contact their senators to ask them to fix how doctors are paid under Medicare.

Notably, the targeted states are home to senators whose support is crucial for passage of an SGR bill -- including North Dakota, home to fiscally conservative Democrat Kent Conrad, and Maine, home to Republican Olympia Snowe.

Conrad has said he wouldn't vote for the SGR bill unless its cost is offset. Snowe, meanwhile, is seen by Democrats as having the potential to vote with Democrats on healthcare measures, largely because she was the only Republican to vote to report the healthcare reform measure out of the Finance Committee.

Both the AMA and AARP publicly supported healthcare reform. And both groups said they remain hopeful that reform will still pass, even if it takes longer than anyone expected.

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